Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs

15.2.11

On Saturday, I published an article, Battle for Britain: Fighting the Coalition Government’s Vile Ideology — and Praise for UK Uncut, in which I summarized many facets of the coalition government’s “unprecedented assault on almost every aspect of British society — hard-pressed middle class and working class people, students, schoolchildren, the working poor, the unemployed and the disabled; everyone, in fact, except the rich and the super-rich.” I also noted how, “[d]riven by a repusive ideological desire to smash the British state, and to privatize whatever was not privatized under Margaret Thatcher, John Major, Tony Blair and Gordon Brown, the government was “ferociously pursuing the biggest ever hatchet job on the British state on the basis of economic necessity, counting on the sloth and indifference of the public to disguise their true intentions, and to prevent anyone from scrutinizing how those responsible for the financial crisis — the banking sector, and the corporations committed to wholesale tax avoidance — are not being held accountable.”

In that article, in which I also wondered how, or if a powerful coalition opposed to the cuts would emerge (and praised the campaigning of UK Uncut, which has honed in specifically on the banks and tax avoiders), I mentioned that I would address, in a separate article, the government’s plans to privatize the NHS by stealth, and am pleased to do so below.

Of all the wretched plans put forward by a government that combines arrogance and stupidity to an alarming degree, the biggest gamble is the privatization by stealth of the NHS, which may well alienate voters in huge numbers (as well as endangering the health of the health service) as the effects of health secretary Andrew Lansley’s deranged plans begin to bite. As the Guardian explained when the health and social care bill was unveiled on January 19, the aim is “to abolish all of England’s 152 primary care trusts,” and ten strategic health authorities, “which currently plan services and decide how money should be spent,” and to transfer all of these decisions to GPs, who will form consortia “which will take control of 80% of the NHS budget [£80 bn a year], buying services from providers in the public, private and charity sectors.”

The privatization of the NHS

No one outside the government appears to like the plans. As the Guardian reported on February 4, in an article entitled, “Is anyone in favour of Andrew Lansley’s NHS reforms?” Lansley’s plans to transform the NHS in England “have united in opposition doctors, health thinktanks (and the right-of-centre thinktank Civitas), unions representing the 1.4m-strong NHS workforce, health academics, MPs on the health select committee, the NHS’s major employers, and patients’ representatives,” and “Even David Cameron’s brother-in-law, an NHS cardiologist, thinks the government has got it wrong,” as the Prime Minister admitted the week before. As another article on February 1 explained:

We might expect Unison boss Dave Prentis to claim that “this titanic reorganisation threatens to sink the NHS”. But not the British Medical Journal to run an editorial headlined “Dr Lansley’s monster”, branding the changes “mad” and its chief architect “deluded”. Or the King’s Fund health thinktank’s famously forensic economist John Appleby to in effect accuse Lansley and David Cameron of exaggerating the NHS’s quality of care relative to France to help justify their colossally risky experiment.

As the Guardian explained bluntly, critics are convinced that, because the GPs’ consortia will be “able to opt for treatment from ‘any willing provider’ –- NHS, private healthcare or charity” –- the result will be nothing less than the privatisation of the NHS (see this article by Polly Toynbee for examples of how it will work, and this article by Oliver Huitson on Open Democracy). The Guardian provided criticism from GPs, Midwives, Nurses, Hospital doctors, Public health experts and NHS managers — all of which are worth reading — but what particularly impressed me was a column by Dr. Kailash Chand OBE, a GP who chairs Tameside and Glossop NHS, who, on January 31, under the heading, “NHS reforms are this government’s poll tax,” spelled out both the bigger picture and the problems with the small print. Dr. Chand wrote:

This proposed bill is the biggest challenge to core NHS values. The coalition is planning to turn the NHS over to a plethora of private companies who either commission or provide services, or both. The government’s dismantling of the National Health Service has a genealogy running from Margaret Thatcher through the years of Tony Blair and Gordon Brown to David Cameron’s coalition. The last Labour government laid the groundwork for everything the coalition is planning to do to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of the ill-conceived Labour vision of “public service reform”.

The idea that competition breeds excellence and market forces make everything more efficient is a myth anyway. Two successive governments have now shown that simulating a market ethos in the NHS might bring blips of success, but it carries the potentially fatal consequence of producing erratic behaviour from otherwise sensible people. […]

Why do I have serious misgivings? Apart from the threat of piecemeal privatisation, there seems to be no clarification on what happens if GPs run out of money before the end of the financial year. What happens if GPs will not refer patients to the hospital of their choice because of cost? If a patient is referred to the cheapest provider on financial consideration, will he/she get the best treatment? If hospitals cannot attract “business” from GPs, will they be privatised? How will the conflict of GPs — who are both providers and purchasers — be managed, and what impact might this have on their local hospital?

The legislation proposes a market-based approach that must involve competition between “any willing providers”. This supposes that GP consortia would be able to favour their local provider and build excellent local services. The consortia of GPs established to spend £80 billion on commissioning will become rationing committees, choosing which services should be cut and which groups of patients should lose out. Patients’ lives are about to rest on the bottom line of the GP’s budget.

There is likely to be intolerable pressure on clinicians to dilute their needs-led approach to patient care and instead consider all manner of economic and other factors. Patients should be worried, because GP practices are not set up to do this. They are clinical enterprises, not businesses. Saying “no” to patients does not come easily to GPs.

At the heart of Lansley’s agenda may be the complete privatisation of the NHS — a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly provided, publicly financed body. We are moving away from the traditional health service to one ruled by bogus choice, competition, market forces and supplier diversity. And in this sort of health service the chronically and terminally ill, the mentally ill, those from lower socio-economic groups and the elderly are likely to lose out.

Job losses

On jobs, Lansley’s plans aim “to cull more than 24,000 management staff to reduce bureaucracy,” but while this may please those who have seen the NHS as being too dominated by managers, it is still a huge job loss, and it also disguises the fact that, despite all kinds of promises to protect the NHS, the government is not only privatizing by stealth, but is also happy to see ten percent of the total NHS workforce — at least 100,000 people — put out of work.

This has not been widely reported in the mainstream media, although the Daily Mail managed to note on November 12 that “Tens of thousands of doctors and nurses are facing the axe despite Government promises to protect the NHS from cuts,” and that “Almost 100,000 hospital posts could be at risk across the country, the vast majority of them frontline staff who are caring for patients,” and on February 3 the BBC reported that “Barts and The London NHS Trust is to cut 635 jobs over the next two years as it tries to reduce costs,” explaining that this will involve “200 compulsory job losses” and that “Nearly 10% of nursing posts and 100 beds will go and there will be 290 fewer corporate and back-office roles.”

It is also clear that, behind the headlines, ten percent cuts across the board are taking place everywhere, with large numbers of job losses expected by the end of the financial year. As with much of the government’s butchery, however, it appears that no one will realize until the damage has been done, and an NHS insider I spoke to noted ruefully that it has failed to cause ripples within the unions, as those who still have jobs are content to keep their heads down and hope that they will remain safe.

Will the destruction of the NHS be a rallying call for protestors, as Stuart Weir urged on Open Democracy on Thursday, noting the results of polls showing that it was by “far and away the most popular institution in the country”? Or are we condemned, by the selfishness and indolence of our culture, to watch the Egyptian people rise up in revolt, but do nothing ourselves? As Weir noted:

Lately we have had protests over tuition fees, the abolition of education maintenance allowances, library closures and the sale of forests — the middle class influence seems evident to me.

What astonishes and alarms me is that there is as yet no sign of major protest over the government’s plans for the NHS. The brazen breaking of Liberal Democrat promises to combat and remove tuition fees inspired the rage that fuelled the student protests. Yet … the Conservatives are incubating as great a betrayal over the NHS, an issue which deeply affects the whole population, without creating a similar reaction.

It’s a long time until the major TUC rally and march in London on March 26, entitled, “March for the Alternative: Jobs, Growth, Justice,” but maybe that will be the opportunity for protestors against all the government’s outrageous cuts and “scorched earth” reworkings of existing bodies, as with the NHS, to come together to form a new coalition, and a new way of thinking. The Labour party clearly hopes to galvanize support, as it was revealed on Thursday that Ed Miliband is expected to speak at the rally’s conclusion in Hyde Park, but I’m not convinced, given the scale of the challenges we face as a nation, that the Labour party has the answers — for a variety of reasons, not least the fact that some of the coalition government’s cuts are following up on moves initiated by the Labour government.

What we need, difficult though it may be to imagine, is a revolutionary new political movement that puts people, jobs and “the common good” before ideology and an ingrained servitude to big business and the City, and a truly radical vision of how to achieve that, and not, as we have at the moment, a coalition government committed to making as many people as miserable as possible, and with no clue whatsoever about how to create new jobs, and an opposition party that lacks vision.

These corporations have had Canada’s healthcare under siege for decades but they’re really ramping it up now
It’s easier to control people who are on the edge of losing everything or who fear losing their healthcare if they lose their jobs
In the US, one can get fired for attending a peaceful rally if the employer simply gives a ‘reason’. With corporations spying on citizens & the eroding privacy rights, they can also ‘helpfully inform’ potential employers

Health services aren’t merely rights to be protected, they’re the thin edge of a wedge between social conscience & fearful silence

Thank you very much!. The Guantánamo stuff you are doing is impressive, hope someone finds the way to relieve all these people from such a fate. Health Privatization and Education have started a long time ago here…unfortunately!, I am back to National Health Service…

I appreciate both articles on the situation there. Here in the US, too, the savage government assaults the people to enrich the few. It is also related to the wars and the torture–all part of the same “vile ideology.” May we see resistance to it all grow stronger and bring about a change of course.

Thanks, everyone, and thanks especially to George and Allison for pointing out analogies in Holland and Canada. I think we should be working together to point out the best of our countries to each other, as we’re up against leaders everywhere, enslaved by neoliberal greed, who are looking at other countries and taking nothing but the worst.

‎”What we need, difficult though it may be to imagine, is a revolutionary new political movement that puts people, jobs and “the common good” before ideology and an ingrained servitude to big business and the City, and a truly radical vision of how to achieve that, and not, as we have at the moment, a coalition government committed to making as many people as miserable as possible, and with no clue whatsoever about how to create new jobs, and an opposition party that lacks vision.” Andy Worthington — very nicely said!

Thanks, Tashi. Now we just need to work out how to go about it — not just in the UK, but throughout the West! We need a “New Left,” uncontaminated by old ideas. I see elements of it in the new protest movements focused on the greed of the bankers and the corporations, to be honest, as I think the remorseless, unfettered greed of bankers and corporations is a key part of everything that’s wrong and, without them being fundamentally challenged, ordinary people will be squeezed and marginalized and discarded more and more and more. It should be the inspiration for our own Tahrir Squares. Maybe, when we have hundreds of thousands of decent, hard-working people out of work and our infrastructure collapsing, people will wake up and realize that our politicians are lying to us, and that we are being robbed by psychopaths — literally, by people who do nothing to benefit society as a whole, and are, depending on how you look at it, either immoral, amoral or actually evil.

Very true, very real and very unfortunate for all of us. All these injustices (of every kind) will only spur on more crime, hatred and evil in return.
I never understand how people allow themselves to hoard the wealth — when they can see people are suffering, struggling and starving! Where are their consciences? How do they sleep at night? All I can think of is they have no empathy — they are like narcissistic, soulless beings.

I’ll do that, Andy. In 08 I moved from Holland to Sweden to save my life. I knew the score in Holland, since I had to investigate the new (2006) Dutch system. It is horrid, set up for the reasons you state, and many were tricked. It took me 1 1/2 years to investigate and publish, but I did it. I’m rather driven by Healthcare decline and torture. If you don’t mind I shall send you a FB message or email with a tiny bit more.

Thanks Andy, I shall do so tomorrow with an explanation. It’s a bit brief and hardly up to your standards. Hang on there, here is one. It was my first attempt and all of it turned out to be true. I shall send the other pieces tomorrow by email. Here is the first:http://elektrubadur.se/wp-content/uploads/Dutch-Healthcare.pdf
This was published online in the main Dutch political-intellectual paper, and in Red Pepper, June/July 09. It is also at the Population Health Forum and several blogs. All this thanks to Ken MacLeod, whom you might know. A first stab is on his blog.

Good Andy. The chilling effect is intentional. I was aiming at compact informativeness and impact. You are one of many who have told me that this worked. I’m delighted. Let me add that things have deteriorated more since I wrote that. In Sweden as well.

Hats off to Cuba, who have managed to produce a health care system that puts all of ours to shame. A system originally based on our very own NHS and achieving this with a blockade and without cashing a single check for Guantanamo Bay

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Investigative journalist, author, campaigner, commentator and public speaker. Recognized as an authority on Guantánamo and the “war on terror.” Co-founder, Close Guantánamo, co-director, We Stand With Shaker. Also, singer and songwriter (The Four Fathers) and photographer. Email Andy Worthington